AMA's Accelerating Change in Medical Education Consortium: A student view
A Spotlight on Innovation post with David Savage, a sixth-year MD/PhD student at the University of Texas Medical School at Houston and the medical student member of the AMA’s Accelerating Change in Medical Education Initiative’s national advisory board.
AMA Wire®: You’ve mentioned before that the AMA’s Accelerating Change in Medical Education initiative “has prompted the participant schools to take some educational risks and try new models.” What are some of those risks you think the schools have taken, and how are they now better meeting the needs of today’s medical student?
Savage: A few of the schools in the AMA’s Accelerating Change in Medical Education Consortium took the risk to entirely redesign their curricula, which took a lot of on-campus politicking and advocacy to get buy-in from faculty. Vanderbilt University School of Medicine, for example, moved to a one-year basic science curriculum, and they now have an online system for tracking student competency progress over four years.
The University of Michigan Medical School also totally revamped its curriculum, using a “trunk” and “branches” approach, whereby students get a common core of knowledge in the first two years, and then they choose a branch of clinical coursework for the last two years based on their career interests.
Two medical schools—New York University School of Medicine and the University of California, Davis, School of Medicine—are now offering three-year accelerated undergraduate medical education programs for students who are pre-matched into a residency program before they even start medical school.
These types of innovative programs are unconventional, but already they are demonstrating success, and I believe they will be models for the future. These schools are meeting student needs by helping them get the skills they need to be successful in their residency program of choice, rather than providing a “one-size-fits-all” education experience.
AMA Wire: What have you enjoyed about your experience as a student member of the initiative’s national advisory board?
Savage: I believe that the AMA has been on the leading edge of a nationwide trend toward transformative innovation in medical education. As I was completing my first three years of medical school, I saw the ways that cloud computing, tablets and video streaming had transformed medical education. The AMA’s Accelerating Change in Medical Education national advisory board allowed me to be intricately involved in the screening, selection and evaluation of the initial 11 consortium schools, and later the 21 schools that were added in the second cohort in 2015.
The panel has consistently called upon me to provide the “student perspective” on what might work and what won’t. In the process, I have seen many wonderful ideas take shape, such as the competency learning management system at Vanderbilt, the student engagement process in curriculum redesign at Michigan and the Health Care by the Numbers program at NYU. I have also grown to appreciate the way in which the AMA’s leadership and financial investment in medical education has truly accelerated a process that would have taken much longer without this help.
AMA Wire: What are the key issues that you think the consortium schools are positively addressing?
Savage: 1. The disconnect between medical curricula and the skills needed by residency programs. Traditional medical schools emphasize basic science the first two years, with much of the learning geared toward the USMLE Step 1 exam. The last two years are the traditional hospital rotations, which require the same core rotations, regardless of the specialty that a student may be selecting. Students in rotations are graded by how they present patients on hospital rounds and how they score on end-of-course multiple-choice exams. None of this process assures that students will have certain technical, interpersonal and health system knowledge skills by the time they graduate.
Many consortium schools, like Mayo Medical School, Vanderbilt and the University of Michigan, are redesigning their curricula to focus on achieving core competencies, rather than just grades and written evaluations. In this way, medical schools can assure that their graduates have certain skill sets that meet the needs of residency programs and the patients they serve.
2. Health care delivery science. During the April 2015 consortium meeting at Oregon Health and Science University School of Medicine, the consortium featured a third area of medical education that has gone largely ignored by most medical schools: health care delivery science. This domain focuses on teaching students how the health care system works and how it is financed.
Many students organize and lead electives that teach this important topic during lunch hours and at the end of the school day, but it is not a core element of the traditional curriculum of many schools. Yet residency programs and our patients expect doctors in training to have this information. The recognition of this deficiency in current curricula has led many consortium schools to find ways to integrate health care delivery science and give it the same priority as basic science and clinical care.
AMA Wire: What’s one aspect of the student perspective you think educators better understand now that they’ve worked with students as part of the AMA’s Accelerating Change in Medical Education Initiative?
Savage: I think many educators now appreciate how savvy their students are in finding tools to promote learning. Medical students have limited time and a lot of information to master. During my basic science years of training, students optimized their time by opting out of many live lectures and instead listening to lectures online. This way, students could speed up the replay, slow it down, stop periodically or skip the lecture entirely, depending on how much value the lecture brought to the topic.
Now students are supplementing or replacing school lectures with online tools like Pathoma or Sketchy Micro, and in some cases, they create their own study schedules entirely to maximize performance on USMLE Step 1. Faculty members have begun to embrace these asynchronous and multi-modal methods of learning rather than pushing back against them. This in turn reinforces the faculty role as guides to information, and it allows them to invest their time in activities like small groups for problem-solving and critical-thinking exercises with students.
AMA Wire: What advice would you give students looking to also create change at their medical schools?
Savage: Students wanting to catalyze a curriculum change should reach out to the administrators who run the curriculum and offer to help. My experience working with my school’s Office of Educational Programs has been that they are incredibly receptive to the student perspective. Ever since joining the AMA’s Accelerating Change in Medical Education national advisory panel, I have also been serving as a student representative on the curriculum redesign subcommittee at my school. My teachers have consistently looked toward me for new ideas, and they have asked my opinion on their ideas.
Another suggestion is to always approach your faculty in a collegial and respectful manner. Many faculty members invest immense time in planning their classes, writing their curriculum notes and presenting their lectures. Even if you think a course is not well done, it may not be due to a lack of effort. If you only focus upon the negatives of a class, you may unintentionally hurt feelings and burn bridges toward collaboration. It is much more productive to offer incremental ideas along with a realistic plan for implementing them.